Designing a Trifoliate Flap for Isolated Congenital Alar Rim Defect in Pediatric Patients

Isolated congenital alar rim defects are extremely rare, and there has been no standard technique for the reconstruction of remarkable aesthetic deformity. Herein, we introduce a trifoliate flap for the correction of isolated congenital alar rim defects in pediatric patients. Fifteen cases undergoing nasal alar sulcus rotation flap surgery were analyzed retrospectively. This rotation flap including 3 triangles was a modified flap based on prior studies. Clinical medical notes and photographs were reviewed. Patients’ (or their parents) reported satisfactions with aesthetic outcome were also evaluated during the post-operative follow-up period. In all patients, the isolated congenital alar rim defects were successfully reconstructed. The rotation flap survived and the wound healed primarily. The follow-up period ranged from 6 to 22 months (average 11 months). There were no incidents of flap loss, step-off deformities, nasal obstruction, or alar retraction. At follow-up of post-operative 3 months, pale red scars were observed in the operative area in few patients (2/15). However, these scars gradually became invisible at post-operative 6 months. All patients (or their parents) were satisfied with the aesthetic outcome of this operation. This newly designed trifoliate flap can be an alternative method for the reconstruction of isolated congenital alar rim defects in pediatric patients. The scars of this procedure can be unobvious with fine surgical suture.

Pericranial and scalp rotation flaps for occipitocervical hardware exposure with CSF leak in rheumatoid arthritis patient: A case report and review of the literature

Background: There are several etiologies of craniocervical junction instability (CCJI); trauma, rheumatoid arthritis (RA), infections, tumors, congenital deformity, and degenerative processes. These conditions often require surgery and craniocervical fixation. In rare cases, breakdown of such CCJI fusions (i.e., due to cerebrospinal fluid [CSF] leaks, infection, and wound necrosis) may warrant the utilization of occipital periosteal rescue flaps and scalp rotation flaps to achieve adequate closure. Case Description: A 33-year-old female with RA, cranial settling, and high cervical cord compression underwent an occipitocervical instrumented C0–C3/C4 fusion. Two months later, revision surgery was required due to articular screws pull out, CSF leakage, and infection. At the second surgery, the patient required screws removal, the application of laminar clamps, and sealing the leak with fibrin glue. However, the CSF leak persisted, and the skin edges necrosed leaving the hardware exposed. The third surgery was performed in conjunction with a plastic surgeon. It included operative debridement and covering the instrumentation with a pericranial flap. The resulting cutaneous defect was then additionally reconstructed with a scalp rotation flap. Postoperatively, the patient adequately recovered without sequelae. Conclusion: A 33-year-old female undergoing an occipitocervical fusion developed a postoperative persistent CSF leak, infection, and wound necrosis. This complication warranted the assistance of plastic surgery to attain closure. This required an occipital periosteal rescue flap with an added scalp rotation flap.

Comparison of different surgical techniques of sacrococcygeal pilonidal sinus disease

Pilonidal sinus, especially in young males, is one of the most common diseases of the sacrococcygeal region. Although many surgical techniques have been described for pilonidal sinus disease (PSD), high recurrence rates and patient satisfaction are still controversial with regard to the ideal treatment modality. In this study, we aimed to compare the complications in Primary excision, Limberg flap, elliptical rotation flap and karydakis techniques used in patients with pilonidal sinus disease. The patients who were diagnosed with Pilonidal sinus and underwent surgery between January 2012 and January 2017 were retrospectively analysed from our hospital database. Patients in whom the Primary repair, Limberg flap, elliptical rotation flap and karydakis flap repair performed were divided into four groups. The groups were compared in terms of their demographic characteristics, length of hospitalization, seroma formation, surgical site infections, wound dehiscence, flap necrosis, sensory loss and recurrence. There were 107 patients in the primary group, 70 in the Limberg flap group, 72 in the elliptical rotation flap group and 45 in the karydakis flap group. There was a statistically significant difference between the groups in terms of the length of hospitalization (p < 0.001). The maximum length of hospitalization period was observed in the Limberg group and was 2.06 ± 0.95 days. The minimum duration of hospitalization was 1.00 ± 0.00 days in the karydakis group. Wound site infection was observed mostly in the primary group with 15% frequency, whereas this higher ratio was significant when compared with Elliptical Rotation flap and Karydakis flap groups (p = 0.010, 0.024 respectively). There was no statistically significant difference between the groups in terms of wound dehiscence, flap necrosis, sensory loss and recurrence. There is no consensus on the ideal surgical technique selection for PSD. Our study revealed that wound infection is common in patients undergoing Primary repair and that there is a difference in terms of length of hospitalization for different techniques. We expect the factors we investigate to be a guide for the surgeons.

Outcome of Surgical Management of Sacrococcygeal Pilonidal Sinus Disease with Rotation Flap in 52 Patients—A Retrospective Study

Background Surgical treatment of sacrococcygeal pilonidal sinus disease (SPSD) consists of radical excision of the entire tract and treatment of the resultant raw area. Here, the authors have reviewed the results of the rotation flap for closure of the SPSD. Aim This study aims to evaluate the outcomes following SPSD excision and rotation flap closure. Materials and Methods All patients were treated for SPSD with excision and closure using a rotation flap from January 2010 to September 2018. Cases having a follow-up of at least 6 months post surgery were evaluated. Result A total of 52 patients were included in the study; 42 cases were of primary disease while 10 were of recurrent disease. The patients’ follow-up records on the 3rd day, 10th day, 1 month, and 6 months were evaluated.None of the patients showed any signs of recurrence on follow-ups. One patient developed a hematoma on the third day post surgery which was treated conservatively. One patient developed a seroma in the perianal region on the fifth postoperative day which required aspiration. Both these patients healed well subsequently. Conclusion Rotation flap is a (simple and reliable) treatment option for closure of postexcision SPSD defect. It not only takes the tension away from suture line, but also pushes the gluteal fat from the sides into the midline, obliterating the deep crevice of the natal cleft which is believed to be one of the important factors in the causation of SPSD, thus minimizing recurrence.

Rotation flap distraction osteogenesis for unicoronal synostosis

Unicoronal craniosynostosis is notoriously difficult to treat, with long-term studies demonstrating high rates of relapse and the need for reoperation using open fronto-orbital advancement. Applying the principles of distraction osteogenesis to cranial vault remodeling has demonstrated promising short-term results that compare favorably with traditional methods, with simultaneous correction of both frontofacial and endocranial morphology, along with significant increases in intracranial volume. Here, the authors demonstrate their technique for rotation flap distraction osteogenesis in the treatment of unicoronal synostosis and provide case examples. The video can be found here: https://vimeo.com/519505008.